Computer games treat phobias

Therapists seek virtual reality products under $50

SAN FRANCISCO (CBS.MW) -- When it comes to treating exaggerated fears that interfere with daily life, more mental health experts are turning to PCs for help in getting patients back on track.

Inexpensive computer games provide virtual environments that may be helpful in treating people with phobias, according to an article in the October 2003 issue of CyberPsychology & Behavior, a peer-reviewed journal. More than 11 million Americans suffer from phobias at any given time.

Games such as Half-Life and Unreal Tournament safely and gradually induced high anxiety among 13 phobic patients, who were then treated with conventional therapy, the study said.

Simply imagining a stimulus often isn't enough, and going to the top of a building or taking an airplane flight to conquer a specific fear is too time-consuming or expensive for many people and their therapists, the report said.

"In contrast, exposure to a sufficiently vivid virtual environment can evoke therapeutic levels of anxiety in a manner that is controllable, predictable and reliable," the authors wrote. "Moreover, virtual reality exposure is safe and convenient."

The problem: Some customized virtual reality programs cost $10,000 to $20,000 plus the cost of hardware, putting them out of reach of many therapists. Computer games, on the other hand, typically can come out of the box or be modified with map editing programs for less than $50, the study said.

New frontier for phobia treatment

Such virtual environments represent the future of phobia treatment, said Mark Wiederhold, president of the Virtual Reality Medical Center in San Diego, which has been using similar technology for seven years.

Do arachnids stop you cold? Try a modified version of Half-Life, which replaces monsters with spiders. There's also a version for Microsoft's Xbox and Sony's Playstation 2, Wiederhold said.

Have a fear of small spaces or heights? Enter the world of Unreal Tournament. If fear of getting behind the wheel holds you up, Midtown Madness can help.

In some cases, games' graphics are superior to what's available in more expensive virtual reality instruments, and therapists are learning to harness those tools, he said.

"We're looking to video games to make that next huge leap so we can go from $20,000 to $500, $400 (for the game and console package)," Wiederhold said. "Eventually, you can just get it on the Internet."

Computer games offer therapists a way to guide patients before they test their newly learned coping skills in real-world scenarios, and the simulations may become a standard part of therapy if prices keep coming down, he said.

Price pressure makes products affordable more quickly in the consumer electronics and entertainment industries than in the medical-products sector, he said.

Working out the bugs

Many therapists already use multimedia such as videos and pictures of feared objects to treat specific anxieties, said Reid Wilson, a psychologist in Chapel Hill, N.C., and author of "Don't Panic: Taking Control of Anxiety Attacks."

While games and virtual reality show early promise, the old-school approach called systematic desensitization that provokes high anxiety through imagination works just as well and is how most therapists likely will prefer to practice, he said.

"We want (phobia patients) to have experienced a panic attack and learn they can survive it," Wilson said. "They won't seek it out, but they'll know they can make it."

Therapists balk at the money involved in setting up PC alternatives, he said, noting that even a price tag of $1,000 is enough to deter games from reaching more patients.

"It's going to be a long time before they have easy access to a therapist who can perform these protocols with them," Wilson said. "Most therapists are being trained in cognitive approach with a hierarchy of exposure that will not include virtual reality."

While most programs can be used on PCs and projected on walls, those that also do total immersion on individual head mounts that look like visors remain more expensive, selling for a couple thousand dollars, Wiederhold said.

"An inexpensive head-mount device would allow significant penetration of technology into a home care-based market," he said.

At the Boston University Center for Anxiety and Related Disorders, one of the largest and oldest U.S. anxiety treatment centers, a single virtual reality head mount is newly available as a stepping stone for phobia patients in either a 12-week or intensive one-week treatment program, nurse administrator Bonnie Conklin said.

The device can help patients battle their fears of flying, tight spaces, small animals and heights, with programs on body image and social anxiety in the works, Conklin said.

Those who fear crowds, for example, can set their own pace in the simulation, she said. "They can move themselves onto the subway, and by a click of the finger add more people to come in so they feel more crowded in."

While computer-game therapy works for about 90 percent of phobia patients and 98 percent of those who fear flying specifically, such high-tech supplements aren't for everyone, Wiederhold said.

Still, they may provide new avenues for getting low-cost care to more patients, he said. "Mental health care isn't always available to a lot of people."

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